The fiber optic bronchoscope is used to access the airway via entry through the nasopharynx or oropharynx with continued passage between the true vocal cords and then advancing caudally into the laryngo-tracheo-bronchial tree. Once airway placement is achieved the fiber optic bronchoscope facilitates the diagnostic and therapeutic collection of glandular secretions and/or tissue specimens, foreign bodies, or tumors using the suction channel for the additional placement of flexible biopsy forceps or flexible brushes or flexible needles under direct vision. The ease and safety with which the procedure is performed can be modified by the presence of unexpected anatomic variations and complications that may arise as the bronchoscope navigates the nasopharynx in search of the laryngeal orifice housing the true vocal cords between which the fiber optic bronchoscope will then enter the larynx.
During the procedure a complication or finding may necessitate removal and replacement of the fiber optic bronchoscope and continued control of the airway for rapid reestablishment of patency of the airway or need to be able to mechanically ventilate the lungs while the procedure using a fiber optic bronchoscope ensues to its completion. In order to accomplish these actions it would be necessary to place an endotracheal to able to accept the external diameter of the fiber optic bronchoscope.
The current state of the art would force removal of the fiber optic bronchoscope and either orotracheally intubate in the standard manner or precharge the fiber optic bronchoscope with an endotracheal tube over the fiber optic bronchoscope so that after the fiber optic bronchoscope tip has entered the trachea one can slide the endotracheal tube over the fiber optic bronchoscope and so control the airway and use the endotracheal tube as an access channel allowing removal and replacement of the fiber optic bronchoscope as deemed necessary without going through the cumbersome process followed to initiate airway access. Some of the complicating factors include bleeding, encountering foreign bodies of different shapes and anatomic features such as larynx and vocal cord anomalies or polypoid tumors larger than the caliber of the suction channel of the fiber optic bronchoscope.
Current options for airway management during such procedures include withdrawal of the bronchoscope and intubation of the patient by endotracheal tube including the use of an obturator (See: U.S. Pat. No. 4,960,122) as a guide. As can be appreciated, time is of the essence to maintain airway control and prevent inadequate ventilation and/or oxygenation. Once the patient is stabilized the fiber optic bronchoscopy would be re-started. However, any trauma that has occurred may result in changes to more poorly identifiable access to the laryngo-tracheo-bronchial tree arising from constriction or edema or cyanosis due to complicating hypoxemia such that insertion may be difficult or impossible because of the presence of inadequate anatomic definition.